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Intravesical therapy

Petar Duvnjak, Mario Laguna
The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, < 5% of patient's treated with intravesicular BCG therapy may develop potentially serious complications, including localized infections to the genitourinary tract, mycotic aneurysms and osteomyelitis. We present here a case of a 63-year-old male who developed left coronary and multiple peripheral M...
August 2016: Journal of Radiology Case Reports
Ben H Chew, Dirk Lange
Open ureterolithotomy and pyelolithotomy used to be first line therapy for treating kidney and ureteral stones. With the advent of shockwave lithotripsy, open stone surgery became less prevalent, but once ureteroscopy became more prevalent, open stone surgery became all but extinct. Advances in smaller, more flexible endoscopes and improvements in intracorporeal lithotripters, ureteroscopy has become a mainstay of therapy for kidney stones. The holmium:YAG laser can be utilized through flexible instruments and fragments any stone no matter what it is composed of...
October 19, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
Joshua J Meeks, Benedito A Carneiro, Sachin G Pai, Daniel T Oberlin, Alfred Rademaker, Kyle Fedorchak, Sohail Balasubramanian, Julia Elvin, Nike Beaubier, Francis J Giles
The genetic mechanisms associated with progression of high-risk non-muscle-invasive bladder cancer (HR-NMIBC) have not been described. We conducted selective next-generation sequencing (NGS) of HR-NMIBC and compared the genomic profiles of cancers that responded to intravesical therapy and those that progressed to muscle-invasive or advanced disease. DNA was extracted from paraffin-embedded sections from 25 HR-NMIBCs (22 with T1HG; 3 with TaHG with or without carcinoma in situ). Ten patients with HR-NMIBC developed progression (pT2+ or N+) ("progressors")...
October 14, 2016: Oncotarget
Savino M Di Stasi, Cristian Verri, Francesco Celestino, Francesco De Carlo, Vincenzo Pagliarulo
Bladder cancer is very common and most cases are diagnosed as nonmuscle invasive disease, which is characterized by its propensity to recur and progress. Intravesical therapy is used to delay recurrence and progression, while cystectomy is reserved for patients who are refractory to transurethral resection and intravesical therapy. There is an increasing interest in methods to enhance the delivery of intravesical chemotherapeutic agents to improve efficacy. In vitro and in vivo studies demonstrated that electro-osmosis of mitomycin C (MMC) is more effective in delivering this drug into the urothelium, lamina propria, and superficial muscle layers of the bladder wall than is passive transport...
October 1, 2016: Urologia
Vincenzo Serretta, Cristina Scalici Gesolfo, Vincenza Alonge, Fabrizio Di Maida, Giovanni Caruana
Mitomycin C (MMC) intravesical therapy for "superficial" papillary bladder tumors was firstly introduced in the early seventies with promising results. In the following years, several pharmacokinetic studies investigated its mechanism of action to optimize the intravesical administration. Numerous studies confirmed thereafter both the ablative and the prophylactic efficacy and the low toxicity of MMC when intravesically given. In 1984, a complete response rate of 42% in 60 patients not responsive to thiotepa was reported with intravesical MMC at the dose of 40 mg diluted in 40 ml for 8 weeks...
September 28, 2016: Urologia
Kazuyuki Numakura, Norihiko Tsuchiya, Hiroshi Tsuruta, Susumu Akihama, Mitsuru Saito, Takamitsu Inoue, Shintaro Narita, Mingguo Huang, Shigeru Satoh, Tomonori Habuchi
OBJECTIVE: Intravesical BCG therapy is widely used for the treatment of high-risk, non-muscle-invasive bladder cancer. Among various reported side-effects, decreased bladder capacity is a serious side-effect that significantly worsens patients' quality of life. This article reports the efficacy and safety of bladder hydrodistension (BHD) in six patients with seriously decreased bladder capacity caused by BCG treatment. METHODS: Six patients with low bladder capacity (<100 ml in voiding diaries) and complaint of grade 3 irritative symptoms were diagnosed with decreased bladder capacity and treated with BHD...
October 5, 2016: Scandinavian Journal of Urology
Peter E Clark, Philippe E Spiess, Neeraj Agarwal, Rick Bangs, Stephen A Boorjian, Mark K Buyyounouski, Jason A Efstathiou, Thomas W Flaig, Terence Friedlander, Richard E Greenberg, Khurshid A Guru, Noah Hahn, Harry W Herr, Christopher Hoimes, Brant A Inman, A Karim Kader, Adam S Kibel, Timothy M Kuzel, Subodh M Lele, Joshua J Meeks, Jeff Michalski, Jeffrey S Montgomery, Lance C Pagliaro, Sumanta K Pal, Anthony Patterson, Daniel Petrylak, Elizabeth R Plimack, Kamal S Pohar, Michael P Porter, Wade J Sexton, Arlene O Siefker-Radtke, Guru Sonpavde, Jonathan Tward, Geoffrey Wile, Mary A Dwyer, Courtney Smith
These NCCN Guidelines Insights discuss the major recent updates to the NCCN Guidelines for Bladder Cancer based on the review of the evidence in conjunction with the expert opinion of the panel. Recent updates include (1) refining the recommendation of intravesical bacillus Calmette-Guérin, (2) strengthening the recommendations for perioperative systemic chemotherapy, and (3) incorporating immunotherapy into second-line therapy for locally advanced or metastatic disease. These NCCN Guidelines Insights further discuss factors that affect integration of these recommendations into clinical practice...
October 2016: Journal of the National Comprehensive Cancer Network: JNCCN
Alban Fouasson-Chailloux, Benoit Metayer, Pierre Menu, Lydie Khatchatourian, Joelle Glemarec, Marc Dauty
OBJECTIVE: The loosening of total joint replacement is a frequent complication after total hip arthroplasty (THA). Septic osteolysis should always be feared. We report here a rare case of hip arthroplasty infection due to Mycobacterium bovis after Bacillus Calmette-Guerin (BCG) therapy in a context of bladder cancer. OBSERVATIONS: A 70-year-old man was referred to the department of rheumatology in September 2015, because of a total functional disability of the left lower limb...
September 2016: Annals of Physical and Rehabilitation Medicine
Xun Jin, Peilan Zhang, Li Luo, Hao Cheng, Yunzu Li, Ting Du, Bingwen Zou, Maling Gou
Nanoparticles have promising applications in drug delivery for cancer therapy. Herein, we prepared cationic 1,2-dioleoyl-3-trimethylammonium propane/methoxypoly (ethyleneglycol) (DPP) nanoparticles to deliver doxorubicin (Dox) for intravesical therapy of bladder cancer. The DPP micelles have a mean dynamic diameter of 18.65 nm and a mean zeta potential of +19.6 mV. The DPP micelles could prolong the residence of Dox in the bladder, enhance the penetration of Dox into the bladder wall, and improve cellular uptake of Dox...
2016: International Journal of Nanomedicine
Mauro Ragonese, Marco Racioppi, Pier Francesco Bassi, Luca Di Gianfrancesco, Niccolò Lenci, Alessio Filianoti, Salvatore M Recupero
Mitomycin C (MMC) as an intravesical chemotherapeutic agent is a well-known option for treatment of nonmuscle invasive bladder cancer (NMIBC) recurrence; it is probably the most commonly used agent given its low rate of side effects and its efficacy.Both the American Urologic Association (AUA) and European Association of Urology (EAU) consider MMC as a standard treatment for immediate single-dose postoperative treatment and for adjuvant therapy in low and intermediate-risk NMIBC.Despite the popularity of this agent in the treatment of NMIBCs, many questions regarding the optimal approach to MMC therapy remain unanswered and the schedule widely used is empirical...
October 1, 2016: Urologia
Niccolo Passoni, Bishoy Gayed, Payal Kapur, Arthur I Sagalowsky, Shahrokh F Shariat, Yair Lotan
PURPOSE: To assess if a panel of cell-cycle markers could improve the discrimination of European Organization for Research and Treatment of Cancer (EORTC) and Spanish Urological Club for Oncological Treatment (CUETO) models in predicting recurrence and progression of high-grade non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Between January 2007 and January 2012, every patient with high-grade NMIBC treated with transurethral resection of bladder underwent immunohistochemical staining for 5 biomarkers (p21, p27, p53, KI-67, and cyclin E1)...
September 13, 2016: Urologic Oncology
Bor Kos, Juan Luis Vásquez, Damijan Miklavčič, Gregers G G Hermann, Julie Gehl
OBJECTIVE: Bladder cancer is a cause of considerable morbidity worldwide. Electromotive Drug Administration is a method that combines intravesical chemotherapy with local electric field application. Electroporation has been suggested among other mechanisms as having a possible role in the therapy, so the goal of the present study was to investigate the electric fields present in the bladder wall during the treatment to determine which mechanisms might be involved. MATERIAL AND METHODS: Electromotive Drug Administration involves applying intravesical mitomycin C with direct current of 20 mA delivered through a catheter electrode for 30 min...
2016: PeerJ
Brian D Montgomery, Stephen A Boorjian, Matthew J Ziegelmann, Daniel D Joyce, Brian J Linder
OBJECTIVE: Hemorrhagic cystitis is a challenging clinical entity with limited evidence available to guide treatment. The use of intravesical silver nitrate has been reported, though supporting literature is sparse. Here, we sought to assess outcomes of patients treated with intravesical silver nitrate for refractory hemorrhagic cystitis. MATERIAL AND METHODS: We identified nine patients with refractory hemorrhagic cystitis treated at our institution with intravesical silver nitrate between 2000-2015...
September 2016: Turkish Journal of Urology
J Gual Frau, J Palou, O Rodríguez, R Parada, A Breda, H Villavicencio
UNLABELLED: Adjuvant intravesical bacillus Calmette- Guérin (BCG) therapy is the standard conservative adjuvant treatment and the most effective regimen for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). The term "BCG failure" is generally used to refer to recurrence or progression following BCG therapy, as experienced by many patients. However, the term has been defined inconsistently, and several studies have indicated that patients with a particular pattern of BCG failure have a worse prognosis...
September 2016: Archivos Españoles de Urología
Wei Zhang, Xiaojing Deng, Chunyu Liu, Xu Wang
INTRODUCTION AND HYPOTHESIS: Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic inflammatory condition of the submucosal and muscular layers of the bladder. So far, there is no effective and targeted treatment strategy for IC/PBS. This study aimed to assess the efficacy and safety of intravesical instillation treatment in IC/PBS patients. METHODS: We searched various databases up to October 2015. A network meta-analysis was performed to compare global response assessment (GRA) for different treatment strategies, including botulinum toxin A (BoNTA), bacillus Calmette-Guerin (BCG), resiniferatoxin (RTX), lidocaine, chondroitin sulfate (CS), oxybutynin, and pentosan polysulfate (PPS)...
September 10, 2016: International Urogynecology Journal
Hirokazu Ishida, Hiroki Yamauchi, Hideaki Ito, Hironobu Akino, Osamu Yokoyama
PURPOSE: Ideal therapy for lower urinary tract dysfunction in patients with spinal cord injury (SCI) should decrease detrusor overactivity, thereby promoting urine storage at low intravesical pressure and promoting efficient voiding at low pressure by decreasing detrusor-sphincter dyssynergia. Here we investigated blockade of various α1-adrenoceptors to determine the subtype that was principally responsible for improving the voiding dysfunction. MATERIALS AND METHODS: The effects of the intravenous α1A/D-blocker naftopidil, the α1D-blocker BMY 7378, and the α1A-blocker silodosin were evaluated using cystometrography and external urethral sphincter-electromyography (EMG) in decerebrated, unanesthetized female Sprague-Dawley rats with chronic SCI following transection at Th8...
September 7, 2016: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Marinos Tsiatas, Petros Grivas
Immunotherapy has traditionally been a critical component of the cancer treatment armamentarium in genitourinary (GU) cancers. It has an established role in the management of carefully selected patients with metastatic renal cell carcinoma (RCC) [e.g., high dose interleukin-2 (IL-2)] and non-muscle invasive bladder cancer (NMIBC) [e.g., intravesical Bacillus Calmette-Guérin (BCG)]. In 2010, the sipuleucel-T vaccine was approved by the FDA for the management of metastatic castration-resistant prostate cancer (mCRPC), based on a phase III trial showing overall survival (OS) benefit compared to placebo...
July 2016: Annals of Translational Medicine
Cheong J Lee, Daniel Davila, Anahita Dua, Brian Keyashian, Justin Dux, Gary R Seabrook, Kellie Brown, Michael Malinowski, Robert A Hieb, Brian Lewis
Numerous case reports have highlighted the relationship between BCG therapy and development of systemic mycotic aneurysms but none have established a management algorithm in patients with suspected vascular dissemination of Mycobacterium bovis. Delay in diagnosis of this disease process will lead to delays in initiation of anti- mycobacterium treatment to prevent dissemination into other arterial beds and potentially complicate effective surgical treatment leading to aneurysmal rupture and other devastating vascular consequences...
August 12, 2016: Annals of Vascular Surgery
Laurent Derré, Valérie Cesson, Ilaria Lucca, Yannick Cerantola, Massimo Valerio, Urs Fritschi, Yannis Vlamopoulos, Rodolfo Burruni, Anne-Sophie Legris, Florence Dartiguenave, Dalila Gharbi, Virginie Martin, Laurent Vaucher, Daniel E Speiser, Pedro Romero, Patrice Jichlinski, Denise Nardelli-Haefliger
PURPOSE: Treatments with cancer-vaccines may be delivered as combination therapies for better efficacy. Addition of intravesical immunostimulation with bacteria promotes vaccine-specific T-cells in the bladder and tumor-regression in murine bladder-cancer models. Here we determined whether an adjuvanted cancer-vaccine can be safely administered with concomitant standard intravesical Bacilus-Calmette-Guérin (BCG) therapy and how vaccine-specific immune responses may be modulated in patients with non-muscle-invasive bladder cancer (NMIBC)...
August 12, 2016: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
Theodore G Gabig, Wayne C Waltzer, Terry Whyard, Victor Romanov
The current intravesical treatment of bladder cancer (BC) is limited to a few chemotherapeutics that show imperfect effectiveness and are associated with some serious complications. Thus, there is an urgent need for alternative therapies, especially for patients with high-risk non-muscle invasive (NMIBC). Clostridium perfringens enterotoxin (CPE), cytolytic protein binds to its receptors: claudin 3 and 4 that are expressed in epithelial cells. This binding is followed by rapid cell death. Claudin 4 is present in several epithelial tissue including bladder urothelium and its expression is elevated in some forms of BC...
September 16, 2016: Biochemical and Biophysical Research Communications
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